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MONITORING WELL INSTALLATION REPORT <br /> Date: Y I z CONSTRUCTION rr <br /> Premise Address: 342 '-pl'pflSI Y) Total Depth 61 14 bads <br /> /1/ 53 1�2 cS� Screen Length (from) 15D (to) IGO <br /> Well No.: 138-1�{"I�Filter Pack (from))—(to) 13� <br /> Bentonite (from) 131a (to) 133 <br /> Inspector: J- `1014K, Grout (from) 133 (to) 9 <br /> Drilling rig type MU01 roll" <br /> Permit No. Auger O.D. ix- <br /> A <br /> Drilling Company: stie box y�I Completion - Stove pipe/ (circle one) <br /> - D�1 j1 Lfi� <br /> Driller: S� V <br /> casing <br /> �S height <br /> Consultant <br /> Geologist I'°' Mln�s <br /> ABOVE-GROUND <br /> TIOND CtfAI.M-80X <br /> CONPLEfION <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface 7— <br /> Distance to sewer line "Ou't <br /> Domestic well on site - (y/n ) 133 <br /> If yes, location and distance - ft' <br /> 140 13 n. <br /> a _ <br /> Yq = m <br /> 0 <br /> C <br /> SAMPLING alcryad — c <br /> sxdan <br /> Holding Temperature <br /> Method _ P <br /> ack <br /> Screening Method <br /> Tracking Sheet - (y/n ) — <br /> I S1) ft- = 152 n- <br /> SPOILS <br /> S�aQA[,� SIN S <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location wY Casing type S(b u0 PVC <br /> Blank /40 ft. Screen <br /> Slot size 0.0/0 (47&h <br /> GROUTING Bags cement <br /> Buckets bentonite 2 <br /> Depth to water mad Bags sand/gravel <br /> Mix Ratios Filter Pack type/ 'z,e W11" 12 <br /> Installation Method Surge Block: - y n) <br /> Quantity Installed Discussed with geologist: - (� n ) <br /> Type of method gom V. <br /> EH 29 29 • <br />